![]() Interaction between MRI Units and Implantable Devices Finally, we discuss the elements of an institutional checklist and outline evolving areas in the field. This review provides a brief summary of the basis for MRI interaction with CIEDs followed by a discussion of the current clinical evidence regarding both MR conditional and MR nonconditional products ( 11, 12). Experience and technology have advanced rapidly, and these perspectives need to be modified accordingly ( 9, 10). However, research suggests persistent reluctance among clinicians and institutions to perform MRI in patients with MR nonconditional CIEDs ( 7, 8). For MR nonconditional systems, they make a class IIa (moderate) recommendation that it is reasonable to perform MRI in the absence of fractured, epicardial, or abandoned leads. They make a class I (strong) recommendation for MRI with MR conditional systems only in the context of a standardized institutional workflow. The 2017 Heart Rhythm Society guidelines provide the most up-to-date recommendations for performance of MRI in CIED ( 5). The first MR conditional CIED system was approved by the FDA in 2011 ( 6). MR conditional denotes an item that poses no hazards in a specified MRI environment with specified conditions of use. MR unsafe refers to objects known to pose a risk in all MRI environments. MR nonconditional is a term used in the 2017 Heart Rhythm Society guidelines, which refers to objects that have not been declared MR conditional or safe ( 5). No PPMs or ICDs have been declared MR safe by the Food and Drug Administration (FDA). The American Society for Testing and Materials uses three specific terms to delineate the safety of products in an MRI environment: MR safe, MR conditional, and MR unsafe ( Table 1) ( 4). In at least three cases, the deaths were presumed related to spontaneous fatal arrhythmia ( 3). However, these deaths occurred during unmonitored MRI examinations and were thus inconclusive regarding etiology. Inmr acronym professional#Denial of MRI services is particularly consequential as 50%–75% of patients with a CIED are estimated to require an MRI during their lifetime ( 1).Įarly reports of deaths associated with MRI in patients with permanent pacemakers (PPMs) and implantable cardioverter defibrillators (ICDs) resulted in an inflexible classification of absolute contraindication to CIED for MRI among clinicians, institutions, and professional associations ( 2, 3). However, MRI in the presence of a cardiac implantable electronic device (CIED) still causes trepidation owing to concerns regarding the interaction between electromagnetic fields and the CIED. MRI is the standard imaging modality for an increasing number of medical conditions owing to its excellent spatial resolution, tissue characterization, and lack of ionizing radiation. For this journal-based CME activity, author disclosures are listed at the end of this article. The ACCME requires that the RSNA, as an accredited provider of CME, obtain signed disclosure statements from the authors, editors, and reviewers for this activity. ![]() Physicians should claim only the credit commensurate with the extent of their participation in the activity. The RSNA designates this journal-based SA-CME activity for a maximum of 1.0 AMA PRA Category 1 Credit™. The RSNA is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. ■ Describe the important components of a safe protocol for subjecting patients with CIED to MRI ■ Recognize factors that impart a higher risk for patients with CIED undergoing MRI ■ Identify the potential complications of MRI in patients with a cardiac implantable electronic device (CIED) ■ Future work will focus on MR safe devices that have no conditions on their use and on further exploration of the safety of leadless device designs.Īfter reading the article and taking the test, the reader will be able to: ■ Newer MR conditional devices are now commonly implanted, but patients with older MR nonconditional devices can usually undergo MRI safely with proper precautions. ■ In the past 10 years, evidence has proven concern for serious adverse events to be overstated, with large studies showing limited and manageable side effects. ■ The presence of a pacemaker or implantable cardioverter defibrillator has traditionally been a contraindication for MRI. ![]()
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